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Hand Anatomy

Many years ago, I had an expensive anatomically correct medical model of a human hand that was a regular feature on top of my piano at my studio. It was quite a unique model in the sense that the skin could be removed to see the muscles and the intricate vein systems underneath along with blood flow indicators and numerical signposts. I no longer display this model in my studio due to a complaint from a parent that it “horrified” her child no end! It looks very similar to this:

…it isn’t really that scary!

I named him Frank and I purchased him when I was a first year Conservatorium student. My aim was to better understand what I was working with; what each muscle did; where blood moved and how tension collected and released. I still own Frank but he only gets brought out for my older students – which is a shame. I know that medical models can be horrifying or, “gory and unnecessary” (words used by the aforementioned parent), but they are a wonderful thing to see and touch; they can be purchased for all the organs and limbs of the human body and quite often adorn the shelves in many private doctor surgeries across the world. Mine has the removable parts just like the one in the above picture and my older students derive great pleasure (I suspect it is actually closer to morbid curiosity in some cases) out of putting it back together while following all the little number marks. Part of me wants to rebel and place Frank back atop his rightful throne, but sometimes it is just easier to leave him in the cupboard. On one hand (pun intended), I’d like nothing more than to share something with my students so that they, too, understand how the fingers function. However, on the other, it is difficult to talk a parent down from a ledge once their child has been frightened. Frank was displayed atop my piano with only the best of intentions. I guess now, looking back on it, I should’ve considered that (medical or not) this model had the potential to negatively imprint itself deep into the over-active imagination of a 6 year old.

I wondered for years after if my approach to demonstrating what the hand was really “all about” was a good one with my students. Was it too far? For small children, possibly, but for teenagers, adults, and especially teachers, definitely not. Understanding the hand is something that seems to be only taken seriously by few teachers (at least in my experience), when, in reality, ALL teachers of the piano should hold some sort of anatomical and physiological knowledge of the limb. I feel that regardless of other pedagogues of the Late-Classical and Early Romantic periods, the best person to start with for this brief blog, is Carl Czerny.

Czerny: A True Clinician of the Human Hand

Czerny can be either a blessing or a curse to every pianist, this is mostly due to the divided academic discourse over the benefit of his piano studies. Many piano students the world over know of (and fear) the rigorous technical demands in the two infamous collections of etudes The School of Velocity Op. 299 and The Art of Finger Dexterity Op. 740. It is quite often speculated as to how he amassed the hundreds of etudes in his oeuvre, the implication that the sheer volume may mean they are of no merit. On the contrary…

There is a tonne of anecdotal and historical evidence surrounding Czerny. Whether it be letters to and from pupils, pianists, and royalty, Czerny’s methods of teaching were well known. Perhaps the best and most insightful account was that during a piano lesson, he could sit beside a student, instantly recognise a problem in their hand, and have an etude on the technical issue written for them before the lesson ended. Such feats of pedagogy (unique for their time) added to his already sealed reputation as an exceptional pianist and teacher of some of Europe’s brightest pupils. These historical accounts have led to many recent editors to label him a “clinician of the hand”.

But what exactly is a clinician of the hand? What do they do?

A hand clinician nowadays comes under the medical banner of an Orthopaedic Hand Surgeon. These specialists treat many injuries concerning joints, muscles, and types of damage to the limb. Often times they work alongside Rheumatologists concerning some conditions like bone spurs, RSI (Repetitive Strain Injury), and arthritis; they also work alongside neurosurgeons concerning disorders such as dystonia and, in some cases, muscular dystrophy. Is it correct to place Czerny alongside these medical practitioners? The answer is no. Czerny was no more a doctor than he was a dentist! What is meant by “clinician of the hand” in Czerny’s case is that he understood how the hand worked, what to do with it, and what not to do. He understood how the thumb moved, how the fingers moved, how to change hand positions to create different sounds and effects, and how the arm and wrist worked in conjunction with tone, touch, and technique.

Czerny was no doubt aware of injuries at the keyboard (pianist/teachers like Kalkbrenner had a reputation for torturing their students with maliciously large amounts of repetitions which were restricted to finger movements instead of utilising other movements from the wrist backward up the arm) and, there is also no doubt that he understood tension and release, especially from the wrist and forearm. Czerny was astonished at the freedom that the young Franz Liszt displayed when he visited for his lessons. Czerny recounts how, regardless of Liszt’s whimsical whole body movements, his high fingers and flexible wrist, the playing was nothing short of astonishing; so much so, that Czerny taught him for nothing. The “finger school” of the baroque harpsichordists was still very much a commonly taught pedagogical method in Europe in the early 1800’s. Czerny used a unique blend of Beethoven’s long phrased “legato which breathed” and this “finger school” within his lessons, which eventually incorporated some further use of the wrist. The correspondence between Beethoven and Czerny (especially concerning the interpretation of Beethoven’s newly published music) gives great insight into Czerny as interpreter, transcriber, and pianist. Beethoven entrusted Czerny with performances, even after scolding him for taking excessive liberties via “adding things” to the original music (wonder where Liszt got it from, hmmm?) – they are wonderful to read.

Although Czerny missed the first publication of Gray’s Anatomy by 1 year, it is possible that he would’ve been well aware of the first few volumes of the most influential medical text of the time, the Atlas of Human Anatomy and Surgery by Jean Baptiste Marc Bourgery:

Please note: this book is NOT for the squeamish. Seriously.

But would he have bothered to read it? While it is hypothetical that Czerny knew the preliminary volumes of this book (the entire collection was not published during his life), it is also equally hypothetical that he did not. The lithographs and illustrations (impeccably drawn by artist, Nicolas Henri Jacob) set the benchmark for all medical imagery and surgical procedures for many years after. This unbelievably large text book (yes, you could easily use it as a weapon should you ever face a home intruder!) is now published in its entirety to be purchased by serious collectors, academics, or just for those who have a keen interest in the human body. As for Czerny knowing the book (or knowing similar anatomy guides of the time), it bears mention that his observations on the human hand and its capabilities did not just come down to luck. When looking across the vast expanse of Czerny’s compositions, especially the etudes, those with a keen eye can see that he knew how to immediately, and successfully, solve a problem with beginner pianists, right through to the most competent of virtuosi. As someone who completed all 40 of the Op. 299 studies over the course of three years, I can attest to great results. These results improved the more I practiced them and, along with Op. 740, I still consider them to be a valuable tool for myself and my students. Carl Czerny, regardless of the hatred that many pianists have for his etudes and his sometimes bland, “salonesque” harmonic framework, is still quite often referred to as the forefather of modern piano technique – for very good reason…

I am happy to say I, too, am a part of this tree (my teacher was a student of Arrau!)

I’m just going to blurt this out: I do not believe you can be a successful piano teacher without even a cursory, anatomical knowledge of the hand. In fact, it’s quite absurd to consider anything otherwise. There is no need to begin a degree in medicine nor is there cause for several hours of reading the most dense orthopaedic text books at your local library: Google is your friend. There are also many concise books (including Gray’s Anatomy) that are just as beneficial for understanding the mechanics of the hand. Anyone can pick up Malwine Bree’s treatise on Leschetizky’s methods of teaching, and they can flick through to all of the drawings and pictures of his hand demonstrating how to correctly take chords, but are they REALLY understanding? Are they really understanding Wieck and his focus on the wrist as a reliever of tension? Do they understand the dialogue between the techniques of Matthay and Breithaupt whilst having no knowledge of weight and muscular movement in and around the hand? Finally, do they know and understand what is under their own skin? In a lot of cases, probably not. Reading book after book of pedagogical practices/ideologies is wonderful, but it isn’t the full picture. Just like a mechanic has to lift the bonnet of the car to better understand the problem, we have to lift the layers of skin off our limbs to understand how the machine works underneath (please, don’t take me literally!). This isn’t a direct stab at ALL piano teachers, it is aimed to bring forth the idea that maybe taking a closer, anatomical look could really open some doors and expand thought, creativity, and progression of technique.

Finally, I have to say, if I didn’t understand about the inner workings of the hand at an anatomical level (sometimes, also at a mental level!), I couldn’t ethically teach someone the piano. I mean, when a student comes and says that their 4th and 5th fingers have trouble playing the broken double thirds in Op. 299 no. 11, I don’t want to be a teacher who throws an exercise at them saying “practice this slowly, it will eventually happen” (I would just like to point out that I do know MANY teachers like this), I want to be the teacher who says “Well! Here is WHY they are doing that and here are some ways we may be able to fix it” and make sure they understand how their hands respond to such challenges.

As for the 6 year old who was scared of Frank, she is now 14. She still tells me, on a regular occasion, that should she ever see Frank again, she will most likely set him on fire for ruining her childhood with nightmares. She’s also currently having some trouble with Op. 299 no. 5 of Czerny.